1. ¹Department of Opthalmology, Leiden University Medical Centre, Leiden, The Netherlands
2. ²Nijmegen University Medical Centre, Nijmegen, The Netherlands

Correspondence: JEE Keunen, Institute of Ophthalmology, Nijmegen University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31 42 3613138; Fax: +31 24 3540522; E-mail: j.keunen@ohk.umcn.nl

Received 28 April 2005; Accepted 2 May 2005.

Abstract

Leprosy control programmes are highly successful. As a result, leprosy control will be more and more integrated into the general health services. The existing vertical, specialized control programmes will be dismantled. Eye complications in leprosy have decreased. This is a result of earlier diagnosis and highly effective multidrug treatment (MDT) of leprosy, combined with timely treatment of secondary nerve damage by steroids. Most ocular morbidity is now found among elderly and disabled leprosy patients who were diagnosed before effective MDT treatment became available. Many of these patients live in leprosy settlements. Age-related cataract has become the leading cause of blindness in leprosy. The second cause of blindness is corneal opacification, mainly as a result of neglected exposure keratitis and corneal anaesthesia. The miotic pupils in late multibacillary leprosy, in combination with small central lens opacities, may also lead to blindness. The Vision 2020 Initiative prioritises cataract surgery. Leprosy patients should be actively included. Disabled leprosy patients can also benefit from screening programmes for refractive errors and the provision of spectacles and low vision aids. Determining the most feasible surgical methods for lagophthalmos surgery remains a challenge. For all health and eye care staff, training in leprosy and its eye complications is needed, as well as a change in attitude towards leprosy patients. Staff must be prepared to welcome them in the general health services.